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Sunday, June 24, 2012

Rheumatoid arthritis is the most common inflammatory form of arthritis, affecting about two million Americans. It is a chronic, systemic, autoimmune disease for which there is no cure. However, there are medications available that can control it and put it into remission.

The key is early diagnosis and aggressive treatment.

This article will discuss some of the commonly used disease-modifying anti-rheumatic drugs (DMARDS.) Another article will discuss biologics.

Methotrexate is the "workhorse" of DMARDS. It acts by blocking an enzyme called dihydrofolate reductase, in effect, preventing the proliferation of inflammatory cells. It can be given orally, subcutaneously, and intravenously. Potential side effects include fatigue the day after taking the medication, nausea, hair loss, mouth ulcers, damage to the liver, drop in blood counts, particularly the white blood count, and lung damage which can occur acutely or develop chronically. Methotrexate is also a teratogen, and can cause significant birth defects.

Hydroxychloroquine (Plaquenil) is a drug that has been used to treat malaria but which has some modest effects in treating rheumatoid arthritis. It has an immunomodulatory effect which has not yet been clearly defined. Side effects include skin rash, particularly if the individual is out in the sun, muscle damage, gastrointestinal upset and diarrhea, and damage to the retina of the eyes.

Sulfasalazine (Azulfidine) is a sulfa drug that has anti-inflammatory effect. Once it is metabolized it breaks down into a number of components, one of which is 5-aminosalicylic acid. It is used in Europe much more than in the U.S. Side effects include gastrointestinal upset, drops in blood count, lung inflammation, inflammation of blood vessels, lupus, and a potentially life-threatening condition called Stevens-Johnson syndrome. This causes severe ulceration of the gastrointestinal and respiratory systems.

Leflunomide (Arava) is an oral drug that blocks the synthesis of pyrimidines, which are an active player in RA. Side effects include gastrointestinal upset, rash, liver damage, blood count drops, immune suppression, and birth defects.

Tetracycline is an antibiotic that also has the effect of blocking enzymes that stimulate inflammation. Tetracyclines also have an inhibitory effect on T-cells. Side effects include a photosensitive skin rash, teeth discoloration, lupus, inflammation of blood vessels, and liver damage.

Azathioprine (Imuran) is a potent immunosuppressive drug that blocks the production of purines. It can cause profound drops in blood count, liver toxicity, fever, and can be extremely toxic when combined with other medications such ass allopurinol.

By now your hair is starting to curl. Remember the flip side which is that rheumatoid arthritis itself is a severe disease which can shorten lifespan by ten to fifteen years and cause significant crippling, disability, and internal organ damage.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis Treatment Center http://www.arthritistreatmentcenter.com. He is a former Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html